This article is more than 5 years old. Information may no longer be current.
Lower 30-day mortality risk, higher readmission rates for acute MI, HF across VA hospitals
Click Here to Manage Email Alerts
Older men hospitalized at U.S. Veterans Affairs hospitals had lower rates of 30-day mortality for acute MI and heart failure, but higher rates of 30-day readmissions for acute MI, HF and pneumonia compared with those hospitalized at non-Veterans Affairs hospitals, researchers reported in JAMA.
Sudhakar V. Nuti, of the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and colleagues conducted a cross-sectional analysis of male Medicare fee-for-service beneficiaries aged 65 years or older who were hospitalized for acute MI, HF or pneumonia between 2010 and 2013 at VA and non-VA acute care hospitals. The researchers evaluated patient outcomes for 104 VA and 1,513 non-VA hospitals, with at least 7,900 patients in each condition-outcome analysis cohort.
The primary outcomes were 30-day risk-standardized rates for mortality and readmissions at VA and non-VA hospitals.
According to the findings, mortality rates for acute MI were 13.5% at VA hospitals vs. 13.7% at non-VA hospitals (P = .02). For patients with HF, mortality rates at VA hospitals were 11.4% vs. 11.9% in non-VA hospitals (P = .008). Patients with pneumonia treated at VA hospitals had a higher rate of mortality, however (12.6% vs. 12.2%; P = .045).
Readmission rates were higher at VA hospitals for acute MI (17.8% vs. 17.2%), HF (24.7% vs. 23.5%) and pneumonia (19.4% vs. 18.7%; P < .001 for all).
The researchers also assessed results of metropolitan statistical area comparisons to avoid geographic effects. This analysis yielded similar findings, except mortality rates for patients with pneumonia were not significantly different at VA or non-VA hospitals.
“The finding that risk-standardized mortality rates for [CV] conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” Nuti and colleagues wrote.
In a related editorial, Ashish K. Jha, MD, MPH, from the department of health policy and management at the Harvard T.H. Chan School of Public Health, noted that “the findings are reassuring and make plain that even though the VA has much work to do, it is starting off from a substantially better place than it was 2 decades ago.”
Jha noted, however, that there are still many unanswered questions regarding the VA system, including assessment of patient functional status and how veterans perceive their treatment. In addition, data are still needed on how VA hospitals compare with non-VA hospitals on health care-associated infections, Jha wrote. – by Tracey Romero
Disclosure: Several researchers report working under contract with CMS; one researcher is partially supported by the VA Connecticut Healthcare System. Please see the full study for a list of all other authors’ relevant financial disclosures. Jha reports serving as an attending physician at the Boston VA Healthcare System and serving as a special adviser to former VA Secretary Eric Shinseki through 2012.
Click Here to Manage Email Alerts